improved child spacing among low-income african american women, peggy vander meulen - using fp to...
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Improving Child Spacing Among Healthy Start
Participants
Peggy Vander Meulen, RN, MSN
Throughout the Reproductive Life Course: Opportunities and Challenges Empowering Girls and Women
Global Technical MeetingApril 2 & 3, 2014Washington, D.C.
Objectives
Today will discuss:
Barriers to accessing and utilizing family planning services
Methods to overcome barriers
Importance of Racial Equity
Background
Michigan high Black infant mortality
2003 Kent County highest Black IMR Black : White disparity ratio = 4 : 1
Two-thirds from LBW / PTB
Close ICP = 3 to 4 x more likely LBW
46% low-income African American women pregnant within 18 months
Background
Enroll 450 pregnant & IC women / year
Outreach, case management, education
Mental health services, Fatherhood
85-member coalition for systems work
Local, state & national advocacy
Community engagement
Barriers - Systems
Conservative attitudes towards FP
Teach abstinence-only in schools
Funding cuts to Title X provider
No urban FP clinics in GR
Limited public transportation
Racism (individual, systemic, internal)
Barriers - Personal
Fear racial discrimination / mistrust
Myths & misinformation
Lack of alternative life goals
Fatalism, apathy, embarrassment
Partner opposes use of birth control
Lack transportation, insurance, time
Interventions - Systems
Advocacy
Annual FP Conference
FP Toolkit & EC-friendly pharmacies
Healthy Women’s Resource Guide
Preconception kits & counseling
Racial Equity workshops & toolkits
Interventions - Services
Extensive staff training
Reproductive Live Plans
Bi-weekly home visits
Address associated factors (DV, SA)
System navigation, enhanced services
Men’s program (HV, groups, barbers)
Community education
Percent of Women Who Experienced a Rapid Repeat Pregnancy (Less than 18 months from birth to conception)
46
28.3
7.2
01020304050
All Kent CountyMedicaid-eligibleAfrican American
women
All African Americanwomen in Kent
County
Strong Beginningswomen who were
engaged in theprogram for at least
18 months
Per
cent
Infant Mortality Rate (IMR)Moving average per 1000 live births
Strong Beginnings and Grand Rapids Black IMR
18.3 17.9 17.6 16.7
9.8 9.1 9.5 8.57.1
0
10
20
30
40
50
2005-2008 2005-2009 2005-2010 2005-2011 2005-2012
Rat
e pe
r 1,0
00 li
ve b
irths
Grand Rapids Black IMRStrong Beginnins
-Strong Beginnings 2011 – 2013 IMR: 0 / 1000)
Conclusions – Implications for Practice
Invest in staff training
RN / SW: Professional expertise, technical competence, credibility
CHW (peer mentor): Personal expertise, cultural competence, trust
Talk early, talk often about FP and reproductive health
Conclusions – Implications for Practice
Address clients’ attitudes and motivation (not only give information)
Build on clients’ strengths & life goals
Include partners
Use culturally appropriate education
Overcome practical barriers, and
Address racism & discrimination…
…in order to give women the support they need to access and utilize family planning services and delay subsequent pregnancies for the minimum 18 months recommended
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